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Monkeypox is the latest reemerging zoonosis worldwide. Anyone is susceptible to contracting this infection; however, the clinical presentation may be atypical in a particularly vulnerable group that identifies as men who have sex with men. Herein, we present two cases of patients diagnosed with monkeypox infection, both of whom were also co-infected with human immunodeficiency virus (HIV) and exhibited different degrees of immunosuppression. Notably, the clinical presentations differed significantly. Patients co-infected with HIV are prone to develop clinical features ranging from barely visible lesions to severe or even fatal disease.

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BACKGROUND: Atherosclerosis plays an important role in the pathophysiology of acute coronary syndrome (ACS). CD36 is a scavenger receptor involved in lipid metabolism. Some single-nucleotide variants in the non-coding region could indirectly alter the expression and the function of the protein. OBJECTIVE: The aim of this study was to investigate the gene and protein expression associated with CD36 variants (rs1194182;C > G; rs1049654;C > A, rs1334512;G > T, and rs3211892;G > A) in ACS patients from the western Mexican population. METHODS: We recruited 310 ACS patients and 308 subjects in the control group (CG). Genotyping was determined by TaqMan SNP genotyping assays. CD36 expression at the mRNA level was quantified by TaqMan gene expression assays. Soluble CD36 (sCD36) was measured by enzyme-linked immunosorbent assay. RESULTS: We show that rs1194182G > C variant provides a protective effect with a 1.7-fold lower susceptibility to develop ACS (p  = 0.03); however, this association was masked by diabetes and dyslipidemia. We observed a higher sCD36 concentration in patient with ST-segment elevation myocardial infarction (STEMI) compared with patients with unstable angina (UA) (p  = 0.038). Likewise, in diabetic patients versus non-diabetic (p < 0.001). We observed in patients an increase in CD36 mRNA expression (1.91 times higher) than in the CG (p  = 0.02). CONCLUSION: The rs1194182 seems to be associated with diabetes in a risky manner, in ACS patients and protective for dyslipidemia in both groups. The concentration of sCD36 seems to be associated with the clinical spectrum of the ACS patients and the presence of diabetes, since patients with STEMI present significantly elevated level compared with UA.

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Resumen Hace muchos años se describió el ahora conocido efecto copycat. Se entiende como la reproducción del acto autolesivo, por parte de personas susceptibles, posterior a la exposición a la información en los medios de comunicación relacionada con un suicidio concretado (en noticias, redes sociales, etc.). A partir de la observación en la atención psicológica y psiquiátrica de los pacientes, nuestro grupo ha detectado que esta replicación en realidad forma parte de un espectro mucho más amplio, y que, consecuentemente, otras manifestaciones suelen pasar inadvertidas. Si se trazara un continuum de esas expresiones, en el extremo más severo, se encontraría el suicidio consumado luego de la exposición a dicho material, que es el componente más reconocido hasta la fecha (efecto copycat); no obstante, en otras zonas del espectro, también es posible que las personas experimenten distorsiones cognitivas, componentes obsesivos e intrusivos, ideación pasiva y activa de muerte e intentos no consumados de suicidios. El presente documento se propuso como objetivo describir este fenómeno y, a la vez, ejemplificarlo mediante la exposición de un caso. Resulta probable que el correcto reconocimiento y abordaje fenomenológico sean pasos básicos para establecer los tratamientos y las estrategias preventivas, que garanticen la seguridad de estas personas

Abstract: Long ago, the scientific literature informed about the now well-known copycat effect, understood as a reproduction of the self-injurious act by susceptible individuals after being exposed to suicide-related information in the media (news, social networks, etc.). From observations in psychological and psychiatric care of patients, our group has detected that these manifestations are actually part of a much broader clinical spectrum, where other manifestations can also be found. It would seem plausible that if a spectrum is defined, the most severe end would be consummated suicide, which is the well-recognized component to date (copycat effect); but it is also possible that there is a series of more diverse expressions in other patients after having been exposed to this information, which could include cognitive distortions, obsessive and intrusive phenomena, passive and active ideation of death and unsuccessful suicide attempts. Our purpose with this paper is to explain our observations and present a clinical vignette as an example. We believe that correct recognition and approach to these phenomena is fundamental to establish treatments and preventive strategies that guarantee the safety of this population.

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ABSTRACT While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.

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DNA repair defects are inborn errors of immunity that result in increased apoptosis and oncogenesis. DNA Ligase 4-deficient patients suffer from a wide range of clinical manifestations since early in life, including: microcephaly, dysmorphic facial features, growth failure, developmental delay, mental retardation; hip dysplasia, and other skeletal malformations; as well as a severe combined immunodeficiency, radiosensitivity, and progressive bone marrow failure; or, they may present later in life with hematological neoplasias that respond catastrophically to chemo- and radiotherapy; or, they could be asymptomatic. We describe the clinical, laboratory, and genetic features of five Mexican patients with LIG4 deficiency, together with a review of 36 other patients available in PubMed Medline. Four out of five of our patients are dead from lymphoma or bone marrow failure, with severe infection and massive bleeding; the fifth patient is asymptomatic despite a persistent CD4+ lymphopenia. Most patients reported in the literature are microcephalic females with growth failure, sinopulmonary infections, hypogammaglobulinemia, very low B-cells, and radiosensitivity; while bone marrow failure and malignancy may develop at a later age. Dysmorphic facial features, congenital hip dysplasia, chronic liver disease, gradual pancytopenia, lymphoma or leukemia, thrombocytopenia, and gastrointestinal bleeding have been reported as well. Most mutations are compound heterozygous, and all of them are hypomorphic, with two common truncating mutations accounting for the majority of patients. Stem-cell transplantation after reduced intensity conditioning regimes may be curative.

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AIM: To review all cases of Vogt-Koyanagi-Harada (VKH) disease in an Inflammatory Eye Disease Service in Argentina and to describe the clinical profile and outcomes of treatment. METHODS: The records from patients with VKH disease between January 1980 and December 2008 were retrospectively analyzed for clinical profile, complications, and treatment. Patients were classified according to their initial treatment in group 1: high corticosteroid dose [≥1 mg/(kg·d)] within 2wk of illness onset; group 2: high corticosteroid dose, 2 to 4wk of onset and group 3: patients who received the high dose after 1mo of illness onset, patients who received lower oral doses than 1 mg/(kg·d) without regarding the time of beginning of the disease. RESULTS: A total of 210 eyes of 105 patients were included. The mean age at presentation was 32.6±13y (range: 10-74y), and 86.7% were female. The mean duration of follow up was 144±96.6mo. Patients in the group 1 had significantly higher visual acuity than the other groups (P<0.0001), none had (loss of, or no) light perception at the end of follow up, whereas 24.7% patients in group 3 ended in light perception (P<0.004). CONCLUSION: Patients with early high dose corticosteroid treatment have better visual acuity and fewer complications. Proper timing in referral and treatment is critical for better visual outcome in VKH disease.

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Introducción: el cuadro clínico del dengue ha sido clasificado de múltiples maneras, algunas, aunque vigentes, no satisfacen sus variantes clínicas y epidemiológicas. Objetivo: lograr una clasificación seroclínica epidemiológica que contribuya al control de la enfermedad. Métodos: se toma como base un estudio seroepidemiológico de infección por dengue de una muestra de 535 habitantes seleccionados por un método aleatorio simple en San Mateo, Venezuela, entre mayo de 2007 y mayo de 2008. Como medida de frecuencia de las variables estudiadas se utilizó el porcentaje y su intervalo de confianza. Resultados: el 78,75 por ciento (IC 95 por ciento: 67,986,8) de los casos presentó síntomas típicos y resultaron dengue positivo en el estudio de la IgM, los casos asintomáticos con IgM positiva representaron 13,75 por ciento (IC 95 por ciento: 7,423,7) del total de positivos. Conclusiones: las personas asintomáticas con IgM positiva constituyen una evidencia indirecta de la presencia del vector y de criaderos. La clasificación propuesta denuncia un mayor número de casos al ampliar el espectro clínico de la enfermedad...

Introduction: the clinical picture of dengue has been classified in multiple ways, some, although current, not satisfy its clinical and epidemiological variants. Objective: to achieve a serological, clinical and epidemiological classification contributing to disease control. Methods: present serological-epidemiological study of the infection by dengue is based on a sample of 535 inhabitants selected by simple randomized method in San Mateo, Venezuela, from May, 2007 to May, 2008. As a frequency measure of study variables authors used the percentage and its confidence interval (CI). Results: the 78,75 porceinto (95 porciento CI; 67,9-86,8) of cases had typical symptoms and were positive to dengue in the IgM study, the asymptomatic cases with a positive IgM accounted for the 13,75 porciento (95 porciento CI: 7,4-23,7) of total of positives. Conclusions: the asymptomatic cases with a positive IgM are an indirect evidence of the vector and foci. The classification proposed declares a great number of cases when clinical spectrum of disease was expanded...

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